LOSS OF NOCTURNAL BLOOD-PRESSURE FALL AFTER LIVER-TRANSPLANTATION DURING IMMUNOSUPPRESSIVE THERAPY

Hypertension, which develops after organ transplantation during immuno suppression with cyclosporine (CSA), is often associated with a loss o f nocturnal decrease in blood pressure. Few data correlate circadian b lood pressure patterns before transplant with those observed at fixed time points after transplant, or address the role of alternate immunos uppressive agents such as FK506. FK506 is unrelated structurally to CS A and less often leads to hypertension early after transplant. The pre sent study compared nocturnal blood pressure patterns in patients with end-stage liver disease (ESLD) before transplant to those of transpla nt recipients receiving either FK506 (0.15 mg/kg/day) plus prednisone or CSA (2 to 3 mg/kg/day) plus prednisone and azathioprine after ortho topic liver transplantation. Overnight ambulatory blood pressure profi les were studied in 13 pretransplant ESLD patients and in 34 patients (FK506: n = 13; CSA: n = 21) treated with different steroid doses (24 +/- 11 mg/day FK506; 34 +/- 3 mg/day CSA), according to protocol, 4 we eks (range, 2 to 7 weeks) after liver transplant. Mean blood pressure and heart rate values from awake and nocturnal 5-h time blocks were co mpared to 13 normotensive control subjects. Patients with ESLD were no rmotensive and maintained a normal nocturnal blood pressure fall (125 +/- 3/74 +/- 2 mm Hg awake; 109 +/- 3/60 +/- 2 mm Hg nocturnal). Awake ambulatory blood pressures were higher in CSA patients than in FK506 patients (148 +/- 3/95 +/- 2 v 128 +/- 3/78 +/- 2 mm Hg, respectively; P < .01), despite reduced glomerular filtration rates in both transpl ant groups. Both immunosuppressive regimens led to a loss of nocturnal blood pressure fall, as compared to ESLD patients or normotensive con trols. Nocturnal heart rates were higher in ESLD and transplant patien ts, but decreased from awake levels similarly in all groups. These dat a demonstrate that despite high heart rates, ESLD patients maintain no rmal circadian blood pressure patterns before transplantation with dis turbances of circadian blood pressure appearing soon after liver trans plantation with either FK506 (plus glucocorticoid) or CSA (plus glucoc orticoid) immunosuppression. These disturbances are not limited to pat ients developing hypertension.